Tag Archives: Babies

Are our children’s human rights equally protected?

It’s time to stop hitting our children and give them the same human rights protection afforded to adults says an important new report published by the NSPCC today. The report, which reviews all the available evidence on the impacts of physical punishment on children has been compiled by a team of academics at UCL: Dr Anja Heilmann, Professor Richard Watt and Child of our Time co-editor Professor Yvonne Kelly. Consultant paediatrician Dr Lucy Reynolds told us what she makes of the report and the impact she hopes it will have on policy makers, her colleagues in the medical profession, parents and children themselves.

Equally Protected? A review of the evidence on the physical punishment of children was commissioned by NSPCC Scotland, CHILDREN 1st, Barnardo’s Scotland and the Children and Young People’s Commissioner Scotland.

Photo credit: Paediatrician, UW Health

We know enough now to stop hitting our children

Despite a steady decline in recent decades, the physical punishment of children remains common in British homes. The UK is one of only five countries in the European Union which has not committed to outlawing all physical punishment. British children have less protection from physical violence than adults – a clear violation of international human rights law. And, as a new study commissioned by a group of children’s charities shows, there’s ample evidence physical punishment can damage children and escalate into physical abuse. Author of the report, Dr Anja Heilmann from University College London makes the case for urgent action:

Sadly, it’s only the most extreme forms of child maltreatment that have dominated the headlines in recent years. As far as the media is concerned, there is a dearth of in-depth coverage of the issue of physical punishment, whilst UK governments have not implemented the kind of legal reform that has been happening in countries across the world.

Though there are variations between the nations of the UK, broadly all allow a defence of ‘reasonable punishment’ to a parent accused of lesser physical assault of a child in their care. In Scotland, the defence is one of ‘justifiable assault’.

In 2008, the Scottish Government said :

‘the current position ensures that the law gives children sufficient protection without unnecessarily criminalising parents who lightly smack their child.’

This position, however, is at odds with the substantial evidence base.

Much new research

Internationally, the past decade has seen a surge in the number of studies on the prevalence and outcomes of the physical punishment of children. The most recent substantial review in the UK was a 2008 study in Northern Ireland.

Our aim was to summarise the evidence that has become available since then. To do this we reviewed relevant studies published in English between January 2005 and June 2015. For a definition of physical punishment we used that provided by the United Nations Convention on the Rights of the Child:

‘Corporal’ or ‘physical’ punishment is any punishment in which physical force is used and intended to cause some degree of pain or discomfort, however light.’     

We defined a ‘child’ as anyone under 18. Our initial search yielded more than 1500 returns. We narrowed these down to 98 for in-depth review.

Clear evidence of negative effects

The good news is that the physical punishment of children is in decline. One study found that in 1998 in the UK, 61% of young adults reported having been smacked as a child, while in 2009 this was true for 43%.

Public attitudes have also shifted with the use of physical punishment becoming less and less acceptable and a higher proportion of parents doubting its usefulness.

On a less positive note, we found clear evidence of physical punishment continuing to lead to serious negative outcomes for the child. Four-fifths of the relevant studies found physical punishment was related to increased aggression, delinquency and other anti-social behaviour.

One study in Scotland found that children who had been smacked during their first two years of life were more than twice as likely to have emotional and behavioural problems at age 4 than children who had not been smacked. There was evidence that the more physical punishment suffered by a child, the worse the subsequent problem behaviour.

The evidence suggests that physical punishment is still harmful even when administered in a generally loving and positive family environment – the “loving smack” might be a myth. In addition, all studies that tested it found a link between physical punishment and more serious child maltreatment.

The negative effects continue into adulthood. Again, four out of five relevant studies suggest a link between childhood physical punishment and adult aggression and antisocial behaviour. One large study in the US found that participants who had been physically punished as children were 60% more likely to suffer alcohol or drug dependence.

Legislate and communicate

Though the UK is in a minority in allowing physical punishment, it is not alone. We also looked at five European countries with varying legislative regimes. In all we found a large and growing majority of parents striving to rear their children without physical punishment.

Those countries which had both legislated to give children equal protection against assault and promoted intensive, long-term campaigns of public education had been more effective in changing attitudes and behaviours than those which had pursued either strategy alone.

The international approach to children’s rights is clear: they should be equal to those of adults. The United Nations Convention on the Rights of the Child, which states that all steps to protect children from physical violence should be taken, has been ratified by the UK. And the UK’s continuing failure to explicitly prohibit all corporal punishment in the home has been criticised by the committee that monitors implementation of the Convention.

Act now

“Further research needed” is often one recommendation coming out of a study like this. And there is still a need to know more, for instance, about the efficacy of measures to reduce the incidence of childhood physical punishment.

But no more research is needed to tell us that physical punishment has the potential to damage children and carries the risk of escalation into physical abuse. Our conclusions only reinforce the findings of the 2008 Northern Ireland study.

We need legislation now. And legislation backed up by a large-scale information and awareness campaign.

Equally Protected? A review of the evidence on the physical punishment of children by Dr Anja Heilmann, Professor Yvonne Kelly and Professor Richard G Watt was commissioned by NSPCC Scotland, CHILDREN 1st, Barnardo’s Scotland and the Children and Young People’s Commissioner Scotland.

Photo credit: ellyn.

 

Parenting before and after separation

Do more involved dads have more contact with their child in the event of a separation? And does a mother’s confidence in her ability as a parent take a knock on separation? Researchers Professor Lucinda Platt from the London School of Economics and Political Science and Dr Tina Haux from the University of Kent  have been investigating these questions, using the Millennium Cohort Study, in a Nuffield Foundation funded research project looking at parenting before and after separation.

 

Photo credit: Dani Vazquez

Ethnicity, birthweight and growth in early childhood

Birthweight varies according to ethnic group but height at the age of five does not. Why might that be? Does it tell us anything about the lives of second and third generation immigrants? And does it offer any useful guidance to health professionals hoping to target disadvantaged groups? Professor Yvonne Kelly outlines recent research with colleagues at the ESRC International Centre for Lifecourse Studies looking at differences in birthweight and early growth between ethnic groups.

Birthweight is important. There is a large body of work that suggests links between low birthweight and the development of chronic disease. Height at the age of five is a less straightforward indicator but still an important measure. The relationship between the two is important as well. Rapid post-natal growth may also have a role in later disease risk, and any correlation may tell us something about the lives of people born in the UK to parents born elsewhere.

Earlier research shows that babies born to South Asian and Black mothers weigh up to 300g less than those with White mothers. They are also up to two and a half times more likely than their White counterparts to have low birthweight.

Our study made use of the rich information available in the Millennium Cohort Study and enabled us to drill down further into ethnic differences. We were able to look at White, Indian, Pakistani, Bangladeshi, Black Caribbean and Black African groups.

These, of course, are groups that have very different migration histories. The Black Caribbeans and Indians mainly migrated to the UK in the 1950s and 1960s. The Pakistanis arrived in the 1960s and 1970s, the Bangladeshis in the 1980s and the Black Africans in the 1990s.

Social v biological

If you accept that ethnicity is a social not a biological construct, these variations must be the result of factors that are not intrinsic to the group but tend to go with membership. Relevant factors are likely to be either socioeconomic or maternal.

So, if one group tends to have higher incomes and higher levels of educational attainment, it is likely to have fewer babies with low birthweight. Similarly, if mothers within one group are less likely to smoke they too are likely to have heavier babies.

Because our research compared data on birthweight to those on ethnicity, socioeconomic status and maternal characteristics, it was possible to identify which were most closely associated.

The results suggest that socioeconomic factors are important in explaining birthweight differences in Black Caribbean, Black African, Bangladeshi and Pakistani infants. Maternal characteristics are important in explaining birthweight differences in Indian and Bangladeshi groups. Clearly, both must operate to some extent in all cases.

Our study identifies the dominant factor for each ethnic group and recommends policy-makers pay attention to the different socioeconomic and culturally related profiles of ethnic minority groups when devising policies aimed at reducing inequalities in birthweight.

A question of height

One key maternal characteristic identified was height. Mothers from the Indian, Pakistani and Bangladeshi groups were on average 8cm shorter than White mothers. We speculate that it might take several generations for individuals within ethnic groups to reach their height potential.

And it could be that increases in maternal height do not happen so much for the first couple of migrant generations due to the ‘accumulated effects of disadvantage, including racism, discrimination and poverty that are disproportionately experienced by migrants’. That idea was put to the test in a second study also using MCS data.

The primary aim of this research was to investigate ethnic differences in height at 5 years of age. The same ethnic groups were used. Again, the sample was large and broadly representative of the whole UK.

Playing catch up

In contrast to the findings on birthweight, Indian, Pakistani, Black Caribbean and Black African children were taller than White children at age 5. Bangladeshi children were the same as White children. Birthweight was not entirely irrelevant. It was a weak to moderate predictor of height in White, Pakistani, Bangladeshi and African children.

All the measured variables favoured the White group over all ethnic minorities. This is consistent with the suggestion floated towards the end of the first study that what is happening is that a generation is ‘catching up’, earlier generations having been previously thwarted by such factors as poor nutrition in underdeveloped home countries.

Saying that, catch-up growth is likely to explain only a part of the ethnic height differences identified and further research is important here. It is also important to note that taller children are more inclined to obesity and so the height advantage of ethnic minority children might not translate into a health advantage in adulthood.

The links between ethnicity, birthweight and height in childhood are not, then, straightforward or by any means fully understood. It is clear that outcomes associated with different groups are the result of social and not biological characteristics.

The length of time a group has been established in the UK also appears to play a part with at least some suggestion of a generational ‘catch-up’ effect. Though there may be plenty of inequality left to address, that does at least suggest things are moving in the right direction.

Further information

Why does birthweight vary among ethnic groups in the UK? Findings from the Millennium Cohort Study is research by Yvonne Kelly, Lidia Panico, Mel Bartley, Michael Marmot, James Nazroo and Amanda Sacker and is published in the Journal of Public Health.

Ethnic differences in growth in early childhood: an investigation of two potential mechanisms is research by Amanda Sacker and Yvonne Kelly and is published in the European Journal of Public Health.

Photo credit: moinuddin forhad

[1] Ethnic differences in growth in early childhood: an investigation of two potential mechanisms. A. Sacker, Y. Kelly

Breastfeeding and ethnicity

Helping more mothers breastfeed is a policy goal shared by many governments. Advocates argue that breastfeeding has a positive impact on a child’s physical, cognitive and behavioural development. Because of overlaps with other factors such as a mother’s social class or education, it is hard to measure precisely the degree to which breastfeeding alone benefits a child, but most policy-makers accept there is a benefit and want to know how to encourage more mothers to start it and stick with it. The incidence of breastfeeding varies significantly between women with different ethnic backgrounds and in different ways in the UK and US. Professor Yvonne Kelly from the ESRC International Centre for Lifecourse Studies at UCL asks if there are clues here as to how best to encourage women from different backgrounds to breastfeed their children.

The UK has one of the lowest breastfeeding rates in the world, although according to the NHS Infant Feeding Survey of 2010, the proportion of babies breastfed at birth is 81%, up from 76% in 2005. At three months, the proportion of mothers breastfeeding exclusively is 17%. At six months, the figure is just 1% and that has not changed since 2005.

The same survey found that breastfeeding was most common among mothers who were: aged 30 or over, from minority ethnic groups, left education aged over 18, in managerial and professional occupations and living in the least deprived areas.

The fact that younger, less educated, less well-off women are less likely to breastfeed is not surprising. Indeed, encouraging breastfeeding is at least partly about reducing inherited disadvantage. What may be less obvious (to the majority population, at least) is that ethnicity appears also to be a significant factor.

Millennium Cohort Study

When we looked at the data in the Millennium Cohort Study, which has been tracking the lives of some 20,000 children born at that time, we saw that well over 90% of Black African and Black Caribbean mothers at least started breast feeding.

The figure was over 85% for Indian and Bangladeshi mothers, 75% for Pakistani mothers and 67% for white mothers. Even after adjusting for demographic, economic and psychosocial factors, the difference remains significant.

At three months, with a range of factors considered, Black African mothers are more than 5 times more likely than white mothers to have started and continued to breastfeed. Clearly, if we understood why Black mothers were more likely to breast feed than white mothers we might have a better understanding of how to encourage all mothers to breast feed.

US comparison

An important part of our efforts to gain a clearer picture was to look for similar patterns in similar countries. So we did a comparison with the United States, where the overall rates for breastfeeding are very similar to the UK, as are the links between breastfeeding and socioeconomic status. Not at all similar, however, are the links between ethnicity and breastfeeding.

In the US, the highest rate, according to the National Immunization Survey in 2002, was among Hispanic mothers, at 80%. 72% of white mothers initiated breastfeeding. Only 51% of non-Hispanic black mothers did. So, in the UK black mothers are the most likely to breastfeed. In the US, they are the least likely.

Why the difference, given that usually, health problems suffered disproportionately by black Caribbean people in the UK affect black Americans similarly. Is there a mistake somewhere? We consider the possibility of recall bias in light of the fact that data were collected when the children were 9 months old.

It does seem reasonable to suspect mothers might want to believe they did more breastfeeding than was actually the case. But there is no obvious reason why that bias should apply differently in the UK and US. As the study suggests, the contrasting findings in the UK and US raise important wider questions about the nature of ethnic disadvantage.

One possible answer is that differences in breastfeeding reflect strength of cultural tradition and degree of “integration”. This, of course, can vary for similar ethnic groups in different “host” communities. The important thing is not the ethnic group itself, but the relationship between it and the rest of society.

Dominant cultural practices

Our study found that those who spoke only English at home were less likely to breastfeed. That raises the concern that as incoming groups adopt dominant cultural practices, their tendency to breastfeed will reduce. Cultural factors certainly merit further investigation, given that the only thing we considered in this study was whether English was the main language spoken at home.

Black people in the UK and black people in the US have different histories and, therefore, different identities. There are differences, too, in their “host” communities. In this instance, the very different health systems could be particularly relevant. Maybe future research should concentrate on this relationship rather than the behaviour of groups defined by characteristics that appear to have only secondary significance.

Those responsible for developing and implementing policies aimed at increasing breastfeeding rates in this area would certainly be advised to pay close attention to the different social, economic and cultural profiles of all ethnic groups.

Racial/ethnic differences in breastfeeding initiation and continuation in the United kingdom and comparison with findings in the United States  is research by Yvonne Kelly, Richard Watt and James Nazroo and is published in Pediatrics, Official Journal of the American Academy of Pediatrics..

Photo credit: US Breastfeeding Committee

 

Can a child’s ethnicity tell us something about asthma?

Asthma and wheezing illness are some of the most common childhood illnesses, and appear to have been on the rise in many developed countries. In the ongoing battle against them, considerable research has looked at the links with the surroundings we live in. From the effects of cold weather to dusty homes and living in polluted cities, hundreds of academics and health professionals have tried to put their finger on what external factors might be playing a role in children’s poor health.

Few researchers have looked to see whether there may be a story to tell about links with a child’s ethnicity and whether certain ethnic groups are at higher risk of wheezing illnesses. But now, as part of a wide-ranging ethnicity research project, a team based at the ESRC International Centre for Lifecourse Studies at UCL has been doing just that, as Lidia Panico explains.

About one in five British children has been diagnosed with asthma by a doctor, according to figures from the Health Survey for England, which also shows that wheezing is most common among Black Caribbean children, while Bangladeshi and Black African children suffer least.

A systematic review of UK studies has also found that South Asian children have lower rates of asthma and wheezing illnesses than the general population. In the US, Black children are twice as likely to suffer from asthma than White children. So why do these ethnic differences exist and can they inform our efforts to tackle the problem?

There are quite a few challenges around research in this area and real evidence is thin on the ground, especially when it comes to very young children. Studies have tended to group children from different ethnic backgrounds together or focus only on school age children. Numbers aside, very few studies have been able to go a step further and try to look at what might be behind any observed differences.

Background and biological factors

In our research, we made use of the Millennium Cohort Study, which has been following the health and development of some 20,000 children born in the UK around the turn of the century. This fantastic study has lots of data. This enabled us to look at a host of background and biological factors that might be at play. We looked at the children when they turned 3 years old.

We were able to look at household income, whether mum and dad had jobs and what those jobs were, mum’s age when she gave birth to the child and whether mum lived on her own.

When it came to potential biological causes, we could look to see if parents were smokers, whether the child shared his or her home with other siblings, potentially increasing the risk of catching common infections, furry pets and whether the child had been breastfed.

Other things taken into consideration were whether English was spoken at home and parents’ migration status.

Survey respondents (usually the mother) were asked whether the child had ever suffered from asthma and whether they had had problems with wheezing in the previous 12 months.

Facts and figures

Around one in ten of the children had suffered from asthma at some point while two in ten had wheezed in the last year. Around a fifth of those who had been wheezy in the last year had had more than four attacks in that period with nearly a quarter of them had their sleep disturbed by wheeze on a weekly basis.

As far as ethnic differences were concerned, Black Caribbeans were around 70 per cent more likely than their White counterparts to have had asthma ( 16.2 per cent compared with 11.6 per cent), while Bangladeshis were much less likely at 5.6 per cent.

When we looked at wheezing in the previous 12 months, more than a quarter of Black Caribbean children had suffered compared with one in five White children, so around 40 per cent more likely. Around half of the disadvantage could be explained by social and economic factors, in particular income and the receipt of benefits.

Once again Bangladeshi children were least likely to have wheezed at less than one in ten , especially if their mother was born abroad and if they were living in a bi-lingual or non-English speaking household.

Black African children had lower asthma and wheezing rates than White children, while Indian and Pakistani children had similar rates to White children.

Lower reported rates

Our research team is inclined to think that the apparent South Asian “advantage” might be due to lower reported rates among the Bangladeshi group and should not be attributed to all Asian groups.

With work in the UK and US suggesting South Asians are more likely to be hospitalised with asthma than White children, there is either a story around levels of severity or under reporting/ under diagnosis among these ethnic groups.

Our data suggests that households that would have the most problems communicating with British health services, (new migrants/those who don’t speak English a home or need the survey translated) are least likely to report asthma and wheeze.

By contrast the Black African group which has a similar migration history to the Bangladeshi group, but where English is spoken more frequently, do not show signs of under-reporting.

Migration status and language are key

In order to avoid potentially misleading reports of low asthma and wheezing illness prevalence in some ethnic groups, we should look carefully at migration history and levels of spoken English, particularly in primary care settings.

Ethnic groups are diverse in terms of the prevalence of asthma and wheezing and in their social and economic profiles.

It is also clear that child health provision needs to be carried out within the unique social, economic and cultural context of each group if progress is to be made.

Further information

Lidia Panico is a researcher based at the French Institute for Demographic Studies.

Ethnic variation in childhood asthma and wheezing illnesses: findings from the Millennium Cohort Study is research published in the International Journal of Epidemiology by Lidia Panico, Mel Bartley, Michael Marmot, James Nazroo, Amanda Sacker and Yvonne Kelly.

Photo credit: KristyFaith

Breastfeeding – to a schedule or on demand?

Mums-to-be are frequently advised in baby books that feeding to a schedule is best for their  child. But what does the evidence tell us when it comes to the different approaches and what might that mean for parents, practitioners and policy makers?

Dr Maria Iacovou from the University of Cambridge presents recent evidence breastfeeding research at an ESRC Centre for Lifecourse Studies Policy Seminar.

Photo credit: clogsilk

Related links

The Effect of Breastfeeding on Children’s Cognitive and Non-cognitive Abilities, Labour Economics 19, 2012.

The effects of breastfeeding on children, mothers and employersResearch project information, Institute for Social and Economic Research, University of Essex.